Recently I've heard from collaborators in the US & Europe that #Enterovirus#D68#EVD68 cases are on the rise.
EV-D68 is what I worked on pre-pandemic, & hope to go back to.
A significant autumn 2022 wave has been a recent concern.
So what is D68 & what might this mean?
1/17
#EVD68 is a Picornavirus - a diverse family of viruses. And Enteroviruses are pretty diverse themselves: from Poliovirus, which can cause serious neurological illness, to Rhinovirus - what's behind the common cold 🤧 (and even more in between).
2/17
One of the most notable things about #EVD68 is that in Europe & North America it's historically had biennial autumn outbreaks: in 2014, 2016, & 2018. Also predicted in 2020... but that didn't happen due to pandemic!
Following that pattern, 2022 would be an outbreak season🗓️
3/17
Usually, #EV68 causes mild respiratory symptoms - usually diagnosed in young children - but these can sometimes be more severe.
In the last decade or so, EV-D68 has also been linked to #AFM - acute flaccid myelitis - partial or complete paralysis. Quite concerning.
4/17
I like to say #EVD68 is a virus nobody's heard of - but everyone's had! 🤷🏻♀️
We can see antibody titres against D68 go up through childhood (= prev infection), & find them in >98% adults.
In general they seem to be long-lived, but we don't know how complete protection is.
5/17
I can go on a lot more about #Enterovirus#D68#EVD68 (& I will, in future threads).
But why do we care _now_? With monkeypox & SARS-CoV-2... why am I writing today about this little virus? 🤔
Well - because the pandemic made things a bit weird for all respiratory viruses.
6/17
Particularly in 2020, restrictions to limit #SARSCoV2 (lockdowns, but also closures, masks, awareness, less social activity) _also_ limited all the usual respiratory viruses - including #EVD68
Right up through when we were predicting our next D68 outbreak.
7/17
That doesn't sound so bad - & it wasn't while those viruses stayed away (though notice how quickly Rhino bounced back 😆). But, this potentially led to many children (& adults?) not getting exposed to #EVD68 when they usually would have been.
8/17
This may mean an 'immunity gap' for #EVD68 - that more children (in particular) are susceptible to #EVD68 than during a 'usual' outbreak, since circulation was considerably lower.
Well, it might mean a much larger outbreak: there are more totally-naïve (perhaps also more not-naïve-but-less-well-protected) individuals present.
This could mean, in particular, extra pressure on hospitals & paediatric units this autumn.
10/17
Further, we don't fully understand whether a delayed 1st exposure may have different symptom presentation/outcome. We haven't seen signs of this previously, but with enough cases, even a slight shift could mean even more hospital pressure, severity, and/or AFM.
11/17
This is another a concrete reminder why we should not get complacent about #SARSCoV2 this autumn either!
Any burden it adds to hospitals isn't helpful for any other "post-pandemic restriction" resurgence we see in other respiratory viruses!
12/17
Of course, we don't yet know how things may pan out in the USA or Europe. But I do think, with the lack of #EVD68 circulation in 2020, 2022 being a predicted outbreak year, & these early reports of a rise -- we should be prepared for an outbreak.
13/17
On my end, I'm hoping to update the #Enterovirus#D68#EVD68 builds that I maintain at @nextstrain, ready to pull in new sequences as they come.
I'll post links as soon as I can make that happen!
14/17
I also hope to help provide sequencing of #EVD68 samples from here in #Switzerland, thanks to my recent award (see next tweet).
This will help us take a closer look at patterns we see: ages impacted, symptoms, genetic changes & geographical spread!
15/17
You can get the 3-minute-summary of this thread from my presentation for the Johanna Dürmüller-Bol @DBMR_UniBe award in July:
"Are we better prepared?" asks @EckerleIsabella as she closes #SSM@SwissMicrobe with her keynote on challenges in prevention & preparedness for emerging viruses. #SARSCoV2 & #monkeypox have highlighted these issues; what do we know & where do we stand?
1/N
Perhaps particularly of note are viruses that aren't entirely new, but keep popping up, or appear in new hosts, new places, or with new symptoms a while after identification. How & how often does this happen?
Others we know well & have fought before, but appear again!
2/N
Understanding viral emergence is also not just for viral biologists: there are so many factors that provide influence, from that virus and host to environmental, anthropic, and human-animal interface.
Why is #opendata useful? It's much easier for scientists to share, create tools for, & publicly analyze open sequences.
For example, @Nextstrain creates the #monkeypox builds with open data & provides curated seqs+meta
Our paper on relabelling the internal clades of the #monkeypox to be non-geographical, & proposing a new lineage naming system within Clade IIb, is now out in @PLOSBiology 🙌🏻
This has been an international effort I'm humbled to be part of.
Because it seems like there's a lot of misunderstanding around this paper/proposal - our paper does *not* touch on renaming the #monkeypox virus itself.
We focus on switching to more structured, non-stigmatizing & standardized naming within the virus phylogeny.
2/8
Contrary to what many people believe, there are long-standing efforts to name new viruses, & re-label old virus-related terms (like clades/lineages/strains), to avoid potentially stigmatizing & often inaccurate names. But previously, you didn't hear of it in the media! 😁
3/8
To help your Friday be fantastic 😎, I'm happy to say that we've updated CoVariants with awesome new graphs that load on-demand, speeding up the browsing experience!
HUGE thanks to @richgoater for implementing! 🎉🙏🏻
1/3
With this new addition, graphs now load dynamically as you scroll, speeding up overall loading time & reducing the overhead (especially on older mobile devices 📱).
Check it out on covariants.org/per-country, or the Per Variant or Cases pages!
2/3
As we try to graph more data from more places over longer times, we're always interested in improving our graphs & website!
If you'd like to help, check out the issues on our Github or reach out with an idea - we love contributions! 🥰
Monkeypox:
- We've had warnings about it for years
- We have a vaccine
- We have antivirals
- We have experience w poxviruses
Pandemic Preparedness is a buzzword right now, but if we don't seem to be prepared to effectively combat #monkeypox... Is that what we want?
1/
I am not implying that combatting #monkeypox is easy - & the current outbreak has plenty new to figure out (cryptic transmission, new presentation & lesion locations, MSM spread, ABOBEC mutations).
But we've had so much opportunity to be better prepared than we seem to be.
2/
Very few viruses arrive with the headlines they do in movies.
But #monkeypox really did send heralds for years before the current outbreaks. 📣 The waning of smallpox vaccines. The signs of ongoing transmission.